Smudge is Home! How to start TR?

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Suzanne & Darcy said:
Please be sure to get a +2 test to see where he is at that time. And we can go from there.
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Absolutely will do! Just gave the 4U now (just about 8:30am) so I will test +2 at 10:30am and report back.

Suzanne & Darcy said:
Feeding small snacks (teaspoon or two throughout the early portion of the cycle- before nadir at about +6 for a lot of cats) will help stabilize BG and help prevent too steep of a drop which can trigger a bounce. It’s okay.
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He gave me the okay to leave his wet food in there for a while and to take it away ~3hrs before PMPS.
 
100 point drop from the pre-shot BG. That seems pretty normal

regarding getting blood -- over time, the ears "learn" to bleed as capillary beds develop further.

So for most, they find that not only do you as the caregiver get better at it, the ears also tend to give you blood droplets more easily. This is reminding me that I have not checked Hen's BGs in a couple months. He will probably wriggle and squirm and not be a willing participant as we have fallen out of the routine.
 
Can you try to get a +4?

It’s true that the ears do start to bleed better over time. A lot of people use a sock with a small amount of rice in it and warm it in the microwave and apply it to the ear before a test. I used a very small glass bottle that I had filled with very warm water. I’ve heard of people using empty pill bottles filled with warm water (kind of hot but obviously not hot enough to be uncomfortable.) I only had to do this in the beginning because after some weeks his ears started bleeding more easily. Usually there is one ear that bleeds better than the other.
 
Suzanne & Darcy said:
Good job! Time for a teaspoon of low carb food. Is he eating the DM though? Is that 8% carbs? Or 6%?
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"3.14 grams per 100 kilocalories. Less than 8%"

Suzanne & Darcy said:
Can you try to get a +4?

It’s true that the ears do start to bleed better over time. A lot of people use a sock with a small amount of rice in it and warm it in the microwave and apply it to the ear before a test. I used a very small glass bottle that I had filled with very warm water. I’ve heard of people using empty pill bottles filled with warm water (kind of hot but obviously not hot enough to be uncomfortable.) I only had to do this in the beginning because after some weeks his ears started bleeding more easily. Usually there is one ear that bleeds better than the other.
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He LOVES the rice sock I've been using. I'm bribing him with plain boiled chicken during the pricks and he's a good boy. Just wiggles a lot and it takes me 5-6 to get a good drop. I will definitely be trying a +4 and the +6 for the nadir.
 
Suzanne & Darcy said:
Can you try to get a +4?

It’s true that the ears do start to bleed better over time. A lot of people use a sock with a small amount of rice in it and warm it in the microwave and apply it to the ear before a test. I used a very small glass bottle that I had filled with very warm water. I’ve heard of people using empty pill bottles filled with warm water (kind of hot but obviously not hot enough to be uncomfortable.) I only had to do this in the beginning because after some weeks his ears started bleeding more easily. Usually there is one ear that bleeds better than the other.
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411 @ +4. I don't understand. :(
 
Alli -- what don't you understand?

This cycle, Smudge is bouncing. He wasn't used to those lovely green numbers and coupled with the skipped shot, his numbers bounced almost to the moon. Bounces typically occur due to numbers dropping into a low range, a lower range than your cat is used to, or due to a fast drop in numbers. You got some great advice from Suzanne and from JL.

A couple of things to keep in mind. We are pretty aggressive about insulin in a cat that's post-DKA. Don't immediately think about skipping a shot. You could always give a reduced dose. Bottom line, though, if you're not sure what to do, do what you did -- post and ask for help.

Food and insulin are key in a post-DKA kitty. Ketones arise because your cat is metabolizing fat and producing ketone bodies. That's why food is so important. I'm delighted to see that Smudge ate breakfast like a champ.

Ignore the vet who said 2 meal a day. If you know anyone who's diabetic, they don't starve themselves between meals. It leads to wide swings in blood glucose and for cats, who have fast metabolisms, it makes no sense whatsoever. For some cats, not feeding past nadir may make sense but for now, with Smudge, several small meals is just fine.

Low numbers can be nerve wracking. You did great!!
 
Sienne and Gabby (GA) said:
Alli -- what don't you understand?

This cycle, Smudge is bouncing. He wasn't used to those lovely green numbers and coupled with the skipped shot, his numbers bounced almost to the moon. Bounces typically occur due to numbers dropping into a low range, a lower range than your cat is used to, or due to a fast drop in numbers. You got some great advice from Suzanne and from JL.

A couple of things to keep in mind. We are pretty aggressive about insulin in a cat that's post-DKA. Don't immediately think about skipping a shot. You could always give a reduced dose. Bottom line, though, if you're not sure what to do, do what you did -- post and ask for help.

Food and insulin are key in a post-DKA kitty. Ketones arise because your cat is metabolizing fat and producing ketone bodies. That's why food is so important. I'm delighted to see that Smudge ate breakfast like a champ.

Ignore the vet who said 2 meal a day. If you know anyone who's diabetic, they don't starve themselves between meals. It leads to wide swings in blood glucose and for cats, who have fast metabolisms, it makes no sense whatsoever. For some cats, not feeding past nadir may make sense but for now, with Smudge, several small meals is just fine.

Low numbers can be nerve wracking. You did great!!
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I guess seeing the decline at +2 (yay!) and then increase at +4 (agh!) scares me. I knew it could bounce, but I guess I expected another decline bc I gave 4U this morning. I'm so afraid to do something wrong and for him to go back into DKA. :( It's just so scary for me, I feel like I'm number chasing and when it isn't positive, that I'm failing him.

For the +4, he had his chicken bribe and he was looking for more after I ran out, so I gave him a little food. But then took it away for now.

Everyone here is so amazing. The fact that I can post and get answers nearly immediately is incredible. I don't know how anyone does this without this forum. You're all literal lifesavers and I could not be more grateful.
 
We've all been in your shoes. Gabby was diagnosed with FD, DKA, and hepatic lipidosis. I was a wreak. In addition, I do medical speak really, really well and the vet assumed I knew how to administer insulin. I got home with a cat that had just come out of the ICU and taught myself how to shoot by watching YouTube videos. (I wasn't a member of FDMB yet.) I'm still here because I want to pay it forward.
 
I've been thinking about your skipped shot last night. I want you to know that members here shoot low numbers with depot insulins (Lantus/Glargine, Levemir) on a regular basis as long as kitty is 50 or above, BUT they only do that when they have the data to support what happens with their cat. You've never shot a green before so it's understandably nerve wracking, so you made the choice not to shoot last night and that's okay. Next time you can post for help and you do have options (which by now you may have read about in the stickys since I know you have been studying hard!) You can usually find someone to stay with you also, if you need it. I would have been extremely uncomfortable with you shooting that anyway mostly because of the 4 units which is a very large starting dose for a cat and also because on your spreadsheet (last night) there was literally nothing except a pink AMPS 386 and then a green (92 at +8.25 and PMPS of 84). So I was a bit relieved when you said you had skipped the shot... just because of the fact that there wasn't any data. You're compiling data and hopefully you will get some info from the vets to fill in later on when you get time. Just be sure to put in the numbers that are Lantus ones and/or indicate when he had the short acting insulin (was that just one time?) Keep testing for ketones daily if you can catch him in the litter box (last night you also said it was negative, so I also was relieved about that!) and keep him eating. It's a great sign that he has a good appetite. I had to have a feeding tube put into my cat when he was in DKA and hepatic lipidosis, but it saved his life, I believe.
 
First try lancing for once, on the ear that hasn't bled for me no less! He is 354 @+6. So I guess we are doing a bit if a higher wave here. Bribed with chicken, having some DM now.
 
Bron and Sheba (GA) said:
Is he eating well during the cycles as well as the 2 main meals?
Have you managed to get another ketones urine test yet?
You are doing a really good job looking after Smudge.
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He's eating GREAT. Wonderful appetite. I took his food after AM nadir this time and he ate much more at his PMPS meal than before. I took it away when he was done, but will give back to him for the night after I do a +2 check.

Tried to get another pee stick ketone test this afternoon, but missed it before it absorbed. The blood meter comes tomorrow so I will have it ready for any of the BG tests that give a bigger drop than others.

Thank you, I really am trying! He deserves it. I'd have to say this is even more challenging than my CKD girl and my brain surgery boy's recovery put together.

Edit: couldn't get enough blood for a +2 and he was getting really upset. I had to stop. Ugh.
 
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Sometimes, you can get away with using the same blood drop for a ketone test and a BG test. But the test strip sucks up some of the blood so you need a pretty large droplet to pull that off. We used the Nova Max it worked great.
 
If you’re up a bit longer before bed, I might try again to get another BG test. A 300 on an AT3 isn’t terrible. And you really don’t know that yesterday’s 84 was the lowest he went. He stayed relatively high and flat today (often a sign of a bounce), so another test might clue you in as to whether his BG might be more active tonight (i.e., start heading down).

A bounce is like ripples in a pond after you toss in a rock…the waves (just like high BG during a bounce) are a temporary reaction, and you just have to ride it out and wait for things to settle back to normal.

It’s easy to want to evaluate a dose during a bounce and assume the dose is ok or even too low, but that is a mistake. Bounce cycles aren’t your typical day-to-day reality. Remember, dosing is based on the lowest numbers, not the pre-shots or the highs. :)

[edited to add: today’s higher numbers could also be a result of skipping last night’s shot, which I initially forgot. So higher numbers from skipped shot, or bounce, or both … the data you can collect will be very valuable.]
 
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